How does serous meningitis manifest in children? What is the danger of serous meningitis, how to avoid serious consequences. Ways of infection and causes

Diseases one way or another associated with the brain are one of the most dangerous. These include serous meningitis - an inflammation of the pia mater of the brain of a serous nature. In our article, we tried to tell as fully as possible about the pathogenesis, etiology and treatment of serous meningitis in children, prognosis and preventive measures.

Description of the disease

Serous meningitis most often occurs in preschoolers from 3 to 6 years old, less often in schoolchildren. This is the period when the body is in the active stage of growth, all the body's resources are directed towards development, and therefore the body is weakened. At the same time, the immune system is not fully formed: it is easier for bacteria, viruses and other pathogenic microorganisms to penetrate into the child's body and infect it.

Serous meningitis is an inflammation of the internal pia mater. The disease has an ICD-10 code A87.8 and belongs to the category of "other viral meningitis".

IMPORTANT! Childhood outbreaks of serous meningitis are more common in the summer.

The peculiarity of this form of meningitis is that it affects the inner lining of the brain, and sometimes the brain itself. It also differs from other forms of meningitis in the features of its manifestation: the first symptom is a sharp and strong increase in temperature, which disappears without a trace after a few days, and appears again after a few days.

Another characteristic feature of serous meningitis is that it does not cause necrosis of individual tissues and the release of purulent exudate.

Ways of infection and causes

About 80% of infections are caused by viruses.

The causative agents are enteroviruses, influenza virus, herpes virus, cytomegalovirus, adenovirus, Epstein-Barr virus, paramyxovirus, polio and measles viruses.

The second most frequent source is bacterial infections (tuberculosis, syphilis), the third is fungal infections.

Infection occurs in the following ways:

airborne(when talking to a patient, sneezing, coughing, breathing);
contact(with tactile contact with a patient or objects that have an infection);
water(while bathing during an outbreak of enteroviral meningitis).

Serous meningitis of a non-infectious type (secondary) can occur against the background of brain tumors, cysts and some systemic diseases (measles, chickenpox, polio, mumps).

REFERENCE! In medical practice, there are cases of infection with viral lymphocytic choriomeningitis, or Armstrong's meningitis. The source of the disease is water and food contaminated with biological products (urine, saliva, feces) of infected mice and rats.

Symptoms

If serous meningitis is provoked by viruses, the incubation period lasts from 3 to 18 days. After the infection enters the body, the following symptoms are observed:

Fever, an increase in body temperature up to 40 degrees, sometimes in two stages (a sharp increase - normalization - a second increase in a few days).
Severe, persistent headaches that are aggravated by moving the head, eyes, in bright light, harsh sounds.
Fatigue and general weakness, lethargy, drowsiness.
Pain in muscles and joints.
Nausea and vomiting.
Weight loss.

IMPORTANT! The acute period of serous meningitis lasts 3-5 days.

Despite the fact that the symptoms may resemble the flu, food poisoning, tick-borne encephalitis, and some other diseases, meningitis still has some distinctive features:

taking analgesics does not relieve headaches, the temperature does not go astray;
the patient is unpleasant to touch, the presence of any sensory stimuli, i.e. he prefers to be alone in a dark, quiet place;
an infected child is more likely to lie on its side with its knees pressed to its chest and its head thrown back.

REFERENCE! There is an easy way to distinguish serous meningitis from other conditions. Place your baby on a table and try to rest your chin against your chest. With meningitis, this is almost impossible to do.

Also, the group of meningeal symptoms includes:

inability to straighten a leg bent at a right angle (Kernig's symptom);
Brudzinsky's symptom: if one leg is straightened, the second reflexively bends, or if the head bends, the legs involuntarily bend as well.

Development mechanism

Serous meningitis is predominantly a viral disease. It goes through several stages:

Incubation period. When a virus enters the child's body (with food, water, through household items, during breathing, etc.), it penetrates to the membranes of the brain through blood, lymph, cerebrospinal fluid and begins to actively multiply. By invading tissue membranes, the virus causes inflammation, the first signs of the disease appear, including an increase in temperature. The period can last up to 14 days.
IMPORTANT! If at this stage the disease was not detected, a severe course begins. In 90% of cases, it is fatal.
Pathogens provoke active excretion transparent serous-fibrous fluid, due to which milliard tubercles appear in the affected area.
The reproductive stage. The virus infects the walls of the vessels of the brain, there is a nonspecific allergy. Normal tissue is replaced by connective tissue.
Cerebral edema occurs, some brain centers are affected.

If the child has strong immunity, the virus will die before reaching the meninges.

Treatment

If serous meningitis is diagnosed, the child is admitted to a hospital.

Complex drug treatment is used, which includes taking medications:

antibacterial / antiviral;
immunoglobulin (with reduced immunity);
broad-spectrum antibiotics;
diuretics (drugs that remove excess fluid from the body so that brain edema does not form);
antispasmodics (drugs that reduce headache);
solutions to reduce symptoms of intoxication (intravenous);
antipyretic (at temperatures above 38 degrees);
vitamins of group B, C and others.

Effects

Despite the severe acute period of the disease, which can last up to two weeks, with timely treatment, serous meningitis does not pose a serious threat to the health of the child and disappears without a trace. In this, the serous type is much more gentle than the purulent one.

Rarely, cerebrospinal fluid-hypertensive syndrome becomes a consequence of serous meningitis. In some cases, if the disease has been started, after recovery, frequent headaches, asthenia, problems of the emotional sphere (frequent mood swings, tearfulness, moodiness), memory impairment, and difficulty concentrating may persist. As a rule, these effects completely disappear after a few weeks or months.

The most terrible consequences are known to be tuberculous meningitis. If the diagnosis was not made on time, anti-tuberculosis drugs were not prescribed, after 3-4 weeks a lethal outcome is possible. If treatment is started late, relapses and complications may occur.

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The defeat of the membranes of the spinal cord and brain, provoked by bacteria, viruses, fungi, is defined by official medicine as serous meningitis. The risk group is mainly preschool children. This is exactly the period when the baby begins to attend kindergarten, where there may be potential carriers of the virus. In schoolchildren and adults, this pathology is rarely detected.

The disease is characterized by symptoms accompanying meningitis of a different etiology. This is a high (above 38) temperature, headache, nausea and vomiting. Such symptoms complicate timely diagnosis, since parents often confuse the condition with colds. But the consequences are unfavorable, therefore, the manifestation of any signs should force them to seek medical help.

Causes of the disease

The main pathogens that provoke serous meningitis are bacteria and viruses, less often fungi. But the main cause is enterovirus. The disease is often diagnosed as a complication after previous diseases:

pneumonia;
flu;
measles;
chickenpox;
syphilis;
tuberculosis;
AIDS.

Infection often occurs from an infected person, even during a conversation with him. The greatest peak occurs in the warm season, since many reservoirs are contaminated with harmful microorganisms.

Healthy immunity allows the body to withstand the onslaught of an infiltrated infection. Weakened immunity, unhealthy diet, unhealthy lifestyle allow the virus to penetrate and infect a weakened body. This explains the fact that serous meningitis in adults or children is a consequence of a previous illness. In a weakened organism, enterovirus with blood flow quickly reaches the brain, provoking an initial severe inflammatory process.

Classification of the disease

Modern medicine defines several types of serous meningitis. It depends on the type of pathogen or agent of the disease:

Depending on the severity of the course of the disease at the time of its detection, several more types are determined - primary or secondary degree.

Symptoms of the disease

After infection of the body, the disease can manifest itself in 2-6 days. This is exactly the incubation period in pathology. Treatment is long-term, requiring a hospital stay. Recovery is possible in at least two weeks.

The disease manifests itself with meningeal specific signs:

high body temperature;
fever;
headache;
nausea, vomiting;
pain in the eyes when looking at bright light;
ear pain even with a slight noise;
lack of appetite;
symptom of Brudzinsky or Kernig.

Meningeal signs are the presence of several symptoms at the same time. When Brudzinsky's symptoms are detected, the patient cannot turn his head, bend his neck. When you try to bend one leg, the other bends spontaneously. Determining Kernig's symptom, the patient is invited to raise his leg upright from a prone position. In the presence of a disease, he will not be able to do this. The condition is often accompanied by loss of consciousness.

Diagnostics

A pathology such as serous meningitis is diagnosed quite simply on the basis of the listed symptoms. But this is only enough for a doctor to compile an anamnesis. The patient will have to undergo a complete laboratory and instrumental examination. Serological diagnosis involves:

general blood analysis;
bacteriological analysis;
spinal tap;
Ultrasound, MRI of the brain.

Often, after harvesting the spinal cord, patients feel significant relief. This is further evidence that there is serous meningitis in children or adults. The relief is temporary, since after the intake of fluid, intracranial pressure drops sharply. The treatment is complex and lengthy. This must be done, since the consequences are quite sad.

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Treatment

The occurrence of these symptoms should be of concern, especially to parents. You should not wait for the arrival of the local pediatrician. The course of the disease is rapid, so it is better to call an ambulance.

If at a high temperature the patient cannot bend his legs, turn his head, serous meningitis may be suspected. In this situation, emergency hospitalization is required.

It is undesirable to lower the temperature, to give antibiotics on your own. This will have a temporary effect and complicate the diagnosis. Treatment of serous meningitis does not involve the use of antibacterial drugs at all. After a diagnostic examination, the doctor usually prescribes:

antiviral drugs, often interferon;
to strengthen the immune system, immunoglobulin is prescribed;
to reduce intracranial pressure - diuretics (Furosemide, Lasix);
antispasmodics (No-shpa, Drotaverin);
droppers with prednisolone and ascorbic acid;
colloidal drugs are prescribed in the absence of cardiac pathologies;
antipyretic only when the temperature is above 38 ° C;
Seduxen, Domosan for the prevention of seizures;
vitamin therapy.

For several days, the patient was assigned to bed rest. It is advisable to exclude unnecessary movements. The etiology of the disease is not fully understood. Therefore, it is better to strictly follow all the prescriptions and recommendations of the doctor. This is the only way to quickly achieve complete recovery without sad consequences.

Consequences of serous meningitis

If the patient was provided with timely medical assistance, then the consequences of the disease are favorable. The fever disappears on the 3-4th day, complete recovery is possible in two weeks. If the appeal to a medical institution was untimely, treatment was carried out at home using improvised means, then cerebrospinal fluid-hypertensive syndrome may be noted. It is increased intracranial pressure caused by the accumulation of cerebrospinal fluid (CSF) in the brain.

The situation is serious, provoking:

loss of consciousness;
defective mental and physical development;
impaired hearing and vision, up to complete loss;
kidney pathology;
to whom;
sudden infant death syndrome or death in adults.

The consequences caused by the tuberculosis pathogen are especially dangerous. This form of the disease requires the use of anti-tuberculosis drugs. If this has not been done, then the patient's death may occur on the 22-25th day after the onset of the disease. Inadequate or incomplete treatment provokes a relapse.

Preventive actions

Treatment for any form of meningitis is not injected at the time of hospital discharge. A whole range of preventive measures will be recommended, some of which will have to be followed and carried out for 4 years. Prevention will not hurt those who have been in contact with the patient.

The best prevention is considered to be a strong immune system, which is easy to maintain with a healthy diet, fortified complexes. Adults need to give up alcohol and smoking, children and their parents should ensure a healthy lifestyle. Vaccination against tuberculosis may be recommended. You should not ignore this procedure. This ensures that there is no relapse.

do not visit polluted water bodies;
regularly do wet cleaning, ventilate the room;
wash your hands after the street and before eating;
wash fruits and vegetables before eating;
do not use tap water;
observe the rules of personal hygiene.

Nutrition principles

Not only ready-made vitamin complexes will help to strengthen the immune system, but also the recommendations of alternative medicine. Children need to be educated from early childhood about the risks of unhealthy food. Therefore, it is necessary to exclude carbonated sugary drinks, spicy, fried, fatty foods, salt and sugar to minimize, refuse to visit fast foods. The menu of a person who has had meningitis should include:

fresh vegetables and fruits;
dairy products;
hard cheeses;
lean meats (boiled, steamed);
sea fish and seafood;
nuts;
buckwheat, cheese;
dried fruits.

Serous meningitis is a severe infectious pathology of the lining of the brain. There is a widespread misconception about the causes of this disease. Many people believe meningitis is caused by being out in the cold without a headgear. However, this disease has an exclusively infectious origin. It is most commonly caused by viruses. Hypothermia of the head can only be a provoking factor in the development of the inflammatory process.

Causative agents of the disease

In serous meningitis, inflammation affects the pia mater of the brain, which is closest to the surface of the organ. There are a large number of nerves and blood vessels here, so the symptoms of pathology are pronounced and difficult to tolerate.

This disease is caused by various microorganisms. The most common cause of inflammation is the Coxsackie virus. Also, the causative agents of the following diseases play an important role in the etiology of serous meningitis:

flu;
infectious mononucleosis;
herpes infection;
measles;
rubella;
adenovirus infection ("stomach flu");
(pigs).

In rare cases, the defeat of the meninges is caused by bacteria: Koch's bacillus or treponema pallidum. This happens in patients with tuberculosis or syphilis. The infection enters the brain through the bloodstream. The disease can also be a consequence of the defeat of the body with the yeast candida. But such a pathology is rarely observed, mainly in people with a sharply reduced immunity, for example, in HIV-infected people. Serous-viral meningitis is easier and has a more favorable prognosis than serous-bacterial meningitis.

Allocate the primary and secondary forms of pathology. In the first case, the disease occurs if the infection immediately enters the brain from the outside. Secondary meningitis occurs as a complication of other ailments.

Ways of transmission

The defeat of the pia mater always occurs very quickly, the symptoms of the disease are rapidly increasing. The most common cause of serous-viral meningitis is a microorganism called Coxsackie. These viruses live in the intestines (hence the name - enteroviruses), but they do not lead to damage to the gastrointestinal tract, but to general intoxication of the body. They can cause an infectious disease with fever and rash (hand-foot-mouth syndrome), but central nervous system damage is common.

A viral infection that leads to inflammation of the lining of the brain is spread in the following ways:

Airborne droplets. If viruses accumulate on the mucous membrane of the respiratory tract, then the person releases them when coughing, sneezing and talking.
Contact way. Microorganisms are found on the skin and move to various objects. Sharing things with a sick person can easily become infected. The disease is often spread through dirty fruits and vegetables and unwashed hands.
Through the water. Outbreaks of enterovirus infections are common in resorts where people swim in communal pools. This microorganism can survive in the aquatic environment.

Most often, enterovirus infection occurs in the summer. Children are especially susceptible to infection. Adults get sick less often.

There is also a special form of viral serous pathology - lymphocytic choriomeningitis. With it, inflammation affects not only the soft membranes, but also the vessels of the ventricles of the brain. This infection is spread by rodents - mice and rats. A person becomes infected by eating food and water contaminated with the secretions of sick animals.

Provoking factors

Getting an infection into the body does not always lead to serous-viral meningitis. Additional unfavorable conditions are necessary for the onset of the disease. The development of inflammation in the membranes of the brain can be triggered by the following factors:

Low immunity. This is the main reason why viruses are active. Most often people with a weakened body are susceptible to meningitis. These are patients with chronic diseases, various immunodeficiency states, as well as undergoing treatment with cytostatics and corticosteroids.
Frequent viral infections. If a child constantly has a cold, there is a high risk of getting a complication of the disease in the form of inflammation of the meninges.
Hypothermia of the body. This factor does not play a major role in the occurrence of serous meningitis. Excessive exposure to the cold can only indirectly affect the development of the disease. Hypothermia usually contributes to frequent colds, and meningitis occurs as a complication.

In childhood, the following circumstances may contribute to the development of meningitis:

prematurity of the baby;
intrauterine infection with rubella and other viral diseases;
birth trauma;
congenital insufficiency of immunity.

These children are at increased risk of getting sick.

The difference between the serous form of the disease and purulent

It is important to make a differential diagnosis of serous and purulent meningitis. This is necessary for choosing the right treatment tactics. The two types of disease differ in etiology, pathological changes and clinical presentation. The serous form of meningitis is most often caused by viruses, with inflammation in the membranes of the brain, not pus is formed, but exudate. Nerve cells do not die off.

The purulent form is most often associated with brain damage by meningococci. It is characterized by neuronal death. Purulent contents appear in the membranes. This is much more severe and has more dangerous consequences than serous. Diagnostic tests help to distinguish one form of the disease from another.

Incubation period

The incubation period for serous meningitis can vary in duration. Its duration depends on the type of pathogen. For most viral infections, the latency period is 2 to 5 days. With rubella, it can increase up to 2 weeks. In children 2-6 years old, the incubation period can last 1-2 weeks.

At this time, a person does not feel any deviations in well-being. Only in young children under 1 year old can you notice some changes in behavior. Babies often cry, are capricious, their appetite decreases and their sleep is disturbed.

Common symptoms of the disease

After the incubation period, an intermediate (prodromal) stage of the disease begins. It is characterized by a slight increase in temperature, weakness, fatigue, and decreased appetite. After this, acute signs of serous meningitis develop:

There is a severe headache, which is localized in the temporomandibular region and radiates to the neck. Patients describe this sensation as extremely excruciating. With noise and bright light, the pain is worse. In this case, analgesics practically do not help.
The temperature rises sharply (up to 40 degrees). Fever lasts 2-4 days, then decreases slightly. But after a while, the temperature rises again.
Pain in the head is accompanied by nausea, severe vomiting "fountain" due to increased intracranial pressure and irritation of the vomiting center.
A sick person cannot stand bright light and harsh sounds. His skin becomes very sensitive to touch. The condition improves somewhat when you are in a quiet, darkened room.
The patient lies in a characteristic position: the legs are pulled up to the body, the arms are pressed to the chest, and the head is thrown back. In this position, it becomes somewhat easier for him.
Signs of general intoxication appear: severe weakness and malaise, aching joints.
There may be a slight clouding of consciousness.
If there are nerve damage, then there are disorders of swallowing, movements and double vision.

Features of symptoms in children

In childhood, signs of serous inflammation of the meninges have their own characteristics. In addition to the symptoms listed above, the child may have colds: cough, runny nose, sore throat. The high temperature is accompanied by cramps in the limbs, delirium and hallucinations.

Infants have bulging and tension in the fontanel area. The child becomes irritable, whiny, capricious. The kid constantly screams in a monotonous voice, doctors call this symptom "brain cry".

A rash with this disease usually does not appear, except for those cases when meningitis occurs against the background of a viral infection with skin manifestations (measles, rubella).

Meningeal symptoms

The general manifestations of serous meningitis associated with intoxication of the body were described above. But there are also specific signs of this disease, which play an important role in the diagnosis. These include:

Tension of the cervical and occipital muscles. The patient cannot press his head to his chest due to increased muscle tone.
Kernig's symptom. If the patient's leg is bent in the supine position, then there is a strong muscle tension. Sometimes the patient cannot even straighten the limb.
Brudzinsky's symptoms. When the head is tilted, a person involuntarily pulls his legs towards the body. This is a sign of irritation of the lining of the brain. Also, when one leg is bent, the other limb is pulled up to the body. These symptoms are not always observed in the serous form of the disease.
Lesage symptom. It is observed in infants. If the child is lifted and held in an upright position, then he bends his legs and pulls them towards the body.

The doctor conducts the identification of these symptoms during the diagnostic examination of the patient.

Complications in adults

Severe consequences of serous meningitis in adults are rare. The disease can be complicated by pneumonia, inflammation of the heart membrane, arthritis. Sometimes vision or hearing deteriorates. Occasional pain and noise in the head is possible.

The most dangerous complication of serous meningitis is the addition of a bacterial infection and the transition of the disease to a purulent form. Also, inflammation can spread from the lining of the brain to the gray matter. To avoid such severe consequences, it is necessary to start treatment of the disease in a timely manner.

Complications in children

In childhood, complications occur more often than in adults. Pathology can negatively affect the development of the child. The following consequences of serous meningitis in children are possible:

mental retardation;
hearing impairment;
strabismus;
decreased vision clarity;
trembling and involuntary movements of the eyeballs;
epileptic seizures.

At the first signs of the disease, it is necessary to urgently call a doctor. Timely treatment will minimize the risk of complications.

Diagnostics

During the examination, the doctor determines the signs of damage to the lining of the brain. The specialist detects the symptoms of Kernig, Brudzinsky and Lesage (in children), as well as the tension of the neck muscles.

An important role in the differential diagnosis of serous meningitis is played by a lumbar puncture. Under anesthesia, a puncture is made with a long needle in the lumbar region. Cerebrospinal fluid (CSF) is taken for analysis. Her research allows you to distinguish the serous form of the disease from the purulent one. If the protein in the cerebrospinal fluid is slightly increased and lymphocytes predominate, then this indicates viral meningitis. If the norms of protein content are greatly exceeded and the number of neutrophils is increased, then this indicates a purulent form of the disease.

Additionally, they can prescribe an MRI and CT scan of the brain, as well as a blood test for viral infections.

Treatment methods

With serous inflammation of the meninges, the patient is urgently hospitalized. It is advisable to place the patient in a darkened room, where there are no external stimuli (noises, bright light). Strict bed rest is recommended. In the hospital, drug treatment is carried out:

To reduce intoxication of the body, patients are given droppers with saline solutions, as well as with ascorbic acid and corticosteroids.
To reduce intracranial pressure, diuretics are prescribed: "Veroshpiron", "Furosemide", "Lasix".
At high temperatures, drugs with paracetamol and ibuprofen are prescribed.
Antiviral therapy is carried out with drugs of the interferon series. If meningitis is caused by the causative agent of herpes or infectious mononucleosis, then the use of "Acyclovir" is indicated.
Antibiotics will not cure viral meningitis. But antibacterial drugs of a wide spectrum are still used to prevent the development of a purulent form of the disease.
For pain, the use of "No-Shpa" is useful.
If the child has convulsions, then use drugs "Domosedan" or "Seduxen".
To strengthen the immune system, B vitamins and ascorbic acid are prescribed.
If the disease is caused by Koch's bacillus, pale treponema or yeast fungus, then the use of anti-tuberculosis, anti-syphilitic and antifungal agents is indicated.

In some cases, lumbar punctures are used for therapeutic purposes. Removing part of the cerebrospinal fluid helps to reduce intracranial pressure and headache.

At the stage of recovery, patients are prescribed nootropic drugs (Piracetam, Nootropil, Glycine), as well as preparations with succinic acid. This contributes to the recovery of the brain after illness.

Disease prognosis

The prognosis for serous meningitis of viral etiology is usually favorable. Improvement of the patient's condition with proper treatment occurs in 5-6 days. The disease lasts about 2 weeks, after which complete recovery occurs.

If serous inflammation is caused by tuberculous bacteria or yeast fungi, then it requires a long and persistent treatment. These forms of the disease often recur.

With complications and the transition of the disease to a purulent form, as well as with the spread of pathology to the brain substance, the prognosis significantly worsens.

Prophylaxis

Currently, the specific prevention of this disease has not been developed. To protect yourself from serous inflammation of the meninges of the brain, you need to protect your body from infections. Contact with patients with viral pathologies should be avoided, as well as to strengthen the immune system. If during the summer there is an outbreak of enteroviral diseases, it is necessary to avoid swimming in closed bodies of water.

It is impossible to vaccinate against the serous form of the disease, since it is caused by various kinds of viruses. The Mentsevax vaccine is ineffective in this case. It is designed to protect against purulent meningitis caused by meningococci. You can only take a course of vaccinations against various viral infections (measles, rubella, flu). This will slightly reduce the risk of the disease. However, enteroviruses often become the causative agent of inflammation, and there are no vaccines against them yet.

Serous meningitis is an inflammatory disease that affects the lining of the brain and spinal cord. Most often, the cause of its development is viruses (cause about 80% of cases), some bacteria (tubercle bacillus, pale treponema), pathogenic fungi.

Inflammation of a serous nature can also occur in some systemic diseases, tumor lesions of the brain, its membranes or skull bones. In general, serous meningitis proceeds more easily than purulent meningitis and, unlike the latter, most often occurs in children under 6-8 years of age against a background of reduced immunity.

Forms of serous meningitis

The classification of the disease is based on the etiology and type of pathogen. There are several main types of serous meningitis, which, in addition to the causes of pathology, have a number of clinical features:

Viral forms. They are the most common types of serous meningitis. Most often, the causative agents are the Epstein-Barr virus, enteroviruses, paramyxoviruses, Coxsackie virus, less often influenza, measles, poliomyelitis viruses.
Bacterial forms. In most cases, purulent inflammation with a more severe course is observed. The exception is mycobacterium tuberculosis and causative agents of syphilis (spirochetes or pale treponemas). Isolated forms of serous meningitis due to these infectious agents are extremely rare. Usually, inflammation of the meninges of the brain is part of a complex symptom complex with damage to other organs and systems (miliary tuberculosis, neurosyphilis).
Fungal forms. They are extremely rare in people with a greatly reduced activity of the immune system (with AIDS, radiation sickness, after chemotherapy). The causative agents are fungi from the genus Candida or (less often) Cryptococci.
Other forms. This group includes varieties of the disease caused by protozoal invasion (toxoplasmosis), systemic and autoimmune pathologies, tumors of the nervous system and skull bones. Serous meningitis in adults most often belongs to this group.

Causes of serous meningitis

The main cause of serous meningitis is infection of the membranes of the brain and spinal cord with viruses, certain types of bacteria or fungi, sometimes the disease occurs as a result of autoimmune tissue damage in systemic diseases. However, in a healthy person, the infection process is complicated by a number of factors - first of all, the activity of the immune system and the presence of the blood-brain barrier.

Viral forms of serous meningitis are often complicated by the transition of the inflammatory process to the brain tissue, thereby leading to the development of meningoencephalitis.

Viral forms of serous meningitis in young children can occur as a result of primary infection with enterovirus, Epstein-Barr virus and other pathogens. At an older age, inflammation of the lining of the brain occurs against the background of an already existing viral disease, for example, mumps, flu, measles. At the same time, the primary disease reduces the activity of the body's defenses and additionally creates a significant reservoir of infection, which facilitates the development of meningitis.

In adults, viral forms of serous meningitis, with the exception of acute lymphocytic choriomeningitis, occur only against the background of immunodeficiency. It is caused by a virus carried by rodents (such as rats) and excreted in their urine and feces. This type of pathogen can cause disease in perfectly healthy people.

Bacterial types of serous meningitis in adults and children (tuberculous and syphilitic forms) occur against the background of an existing underlying disease - tuberculosis of various organs or syphilis. The latter at the terminal stages of development is complicated by neurosyphilis - damage to the central nervous system, including the meninges.

Fungal forms of meningitis always occur against the background of a strong decrease in immunity. In all cases of the disease, pathogens penetrate into the meninges in a hematogenous way - from the "entrance gate" or the primary focus of infection in the body.

The symptoms of serous meningitis of viral etiology, despite the wide variety of pathogens, are quite similar. The incubation and prodromal periods take from 5 to 20 days from the moment of infection with the virus, but in some cases the disease develops due to the pathogen persisting in the body. An example of this form of pathology is meningitis caused by herpes viruses (for example, the Epstein-Barr virus). In this case, it may take several months or even years from the moment of infection to the development of the disease. In the prodromal period, nonspecific symptoms may appear - weakness, fatigue, drowsiness, a slight increase in temperature.

Viral serous meningitis in children usually begins acutely, with a rise in temperature to 40–41 ° C, however, the phenomena of increased intracranial pressure (repeated vomiting, severe headache, convulsions) are much less pronounced than in the purulent form of the disease. On days 2–3 from the onset of the disease, there is a stiffness of the occipital muscles, meningeal symptoms are recorded - Kernig, Brudzinsky, Guillain. In most cases, a combination of severe fever and signs of irritation of the meninges are the only manifestations of the disease. Sometimes they are joined by signs of damage to the nervous system - strabismus, changes in mental state, convulsions, paresis. This indicates the involvement of the brain and nerves in the process and adversely affects the prognosis of the consequences of serous meningitis.

Tuberculous meningitis, in contrast to viral, is characterized by a gradual increase in manifestations. A patient with tuberculosis of the lungs, bones, skin or other organs first has headaches, nausea, and unnecessary vomiting for several weeks. Then these symptoms of serous meningitis are joined by the typical, but mild symptoms of Kernig, Brudzinsky, muscle tension in the occiput and neck. In the absence of treatment, the cranial nerves are damaged, primarily the oculomotor, which is manifested by strabismus, anisocoria, and accommodation disorders.

Syphilitic meningitis can occur both acutely and with slow development.

Treatment of serous meningitis is divided into etiotropic (aimed at eliminating the pathogen) and symptomatic.

Diagnostics

To diagnose serous meningitis of viral etiology, the method of neurological examination, the collection of cerebrospinal fluid (puncture), and serological diagnostic methods are used. When examining and questioning the patient, a special role is assigned to the study of the anamnesis - what viral diseases he suffered shortly before the development of symptoms of inflammation of the meninges. Quite often, this allows you to pre-identify the pathogen even before receiving the results of serological tests. The main criteria for the presence of serous meningitis are the so-called meningeal symptoms detected by neurological examination:

Kernig's symptom - the patient, lying on his back and bending his leg at the hip joint, is unable to straighten it (unbend at the knee).
Brudzinsky's symptoms are a group of neurological manifestations that are recorded in meningitis of any nature. The patient bends his legs if his head is bent forward (upper symptom) or pressure on the pubis (pubic symptom). Pressing on the cheek will raise the shoulders and bend the arms at the elbows (buccal symptom).
Guillain's symptom - the patient is pressed on the area of the quadriceps muscle of the thigh, which leads to flexion of the second limb in the hip and knee.

Laboratory research methods used for serous meningitis of any etiology:

Lumbar puncture. The collection and subsequent analysis of cerebrospinal fluid is necessary to determine the form of the disease. Liquor is transparent, slightly scatters light passing through it (opalescent). During its microscopic examination, a significant number of lymphocytes is determined.
Serological tests. Detection of antigens of viruses, bacteria or fungi can be done in the blood or cerebrospinal fluid. This allows you to accurately and reliably determine the nature of the pathogen. Plays a decisive role in the choice of treatment for serous meningitis.

Additional examinations may also be prescribed: electroencephalography, magnetic resonance imaging of the brain, Echo-EG (echoencephalography), tuberculin tests, RPR test (Rapid Plasma Reagin - anticardiolipin test), ophthalmoscopy.

Differential diagnosis of serous meningitis is carried out with purulent forms of the disease, tumor lesions of the meninges, subarachnoid bleeding, tick-borne encephalitis, arachnoiditis.

Serous meningitis treatment

Treatment of serous meningitis is divided into etiotropic (aimed at eliminating the pathogen) and symptomatic. Therapeutic measures directed directly against the pathogenic agent can only be taken after determining its nature - that is, obtaining the results of serological tests. With viral inflammation of the meninges, antiviral drugs are prescribed. Therapy of tuberculous, syphilitic or fungal forms of serous meningitis is carried out with antibiotics and antifungal agents.

Symptomatic therapy often comes down to the appointment of anti-inflammatory drugs from the steroid group - they reduce the severity of the process and reduce the likelihood of developing negative consequences of serous meningitis. In addition, vitamin therapy, a special diet can be indicated. If one of the causes of the disease is a decrease in immunity, immunostimulating drugs are prescribed as an adjuvant.

During the recovery period, nootropic drugs are used that improve the processes of microcirculation and metabolism in the nervous system.

Complications

Viral forms of serous meningitis are often complicated by the transition of the inflammatory process to the brain tissue, thereby leading to the development of meningoencephalitis. In childhood, damage to the nerve centers can have serious consequences - from strabismus and paresis to mental disorders and dementia. At the same time, complications caused by a viral infection are less stable, and with the right approach to treatment, they can be reversible.

In adults, viral forms of serous meningitis, with the exception of acute lymphocytic choriomeningitis, occur only against the background of immunodeficiency.

Meningoencephalitis of a tuberculous or syphilitic nature develops more slowly, but leads to severe irreversible brain damage. One of the late complications of tuberculous meningitis is the development of adhesions that impede the circulation and outflow of cerebrospinal fluid, which can cause hydrocephalus (in children) or a chronic increase in intracranial pressure (in adults).

Forecast

With correctly prescribed treatment, serous meningitis is characterized by a more favorable prognosis than the purulent-inflammatory type of the disease. An exception is the tuberculous form. Despite the slower course, it is more difficult to administer to therapy and has more severe consequences.

The prognosis is also influenced by the level of activity of the immune system - with a significant immunodeficiency, the likelihood of complications, including death, increases.

Prevention measures

There is no specific prevention of serous meningitis, but vaccines against mumps, measles, influenza, chickenpox prevent the development of diseases caused by these viruses.

Contact with patients (both children and adults) should be avoided, since many pathogens of this disease are transmitted by airborne droplets.

Rodent vectors are monitored to prevent acute lymphocytic choriomeningitis in endemic areas.

In order to avoid the development of tuberculous and syphilitic forms of meningitis, it is necessary to observe preventive measures for these diseases (screening measures, exclusion of contact with patients).

Preventive measures are especially important for people with lowered immunity - with immunodeficiency, undergoing treatment for cancer.

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Serous meningitis is an inflammation of the membranes of the brain, provoked by the activation of pathogenic microflora of viral, fungal and bacterial genesis. It is accompanied by a pronounced symptom complex that helps in diagnosis. It is possible to determine the presence of serous meningitis and differentiate its causative agent only by bacteriological examination of the cerebrospinal fluid.

There are two ways of infection:

Direct - pathogenic microorganisms enter through mucous membranes, wounds and household appliances from a sick person to a healthy one.
Indirect - the inflammatory process develops as a result of a skull injury, in which the meninges are infected.

A distinctive feature of the serous type of meningitis is the active production of serous exudate. There is no necrotic process, as well as purulent accumulations, which makes this type of disease less dangerous.

After the penetration of microbes into the body and reduced immunity, they spread and settle in biological fluids. Weakened immunity plays a key role in the onset of the disease. If the natural defenses are included in the work immediately, then meningitis can be suppressed on its own without outside help at the stage of the appearance of the first signs of a respiratory disease.

Most often, the inflammatory process is triggered by a viral infection that develops with the activation of cytomegalovirus, herpes virus, enteroviruses, measles and mumps viruses. Less often, the disease is of a bacterial nature, and fungal lesions are diagnosed extremely rarely and are a consequence of the progression of autoimmune processes in the body.

The risk group includes preschool children attending kindergarten. Frequent respiratory illnesses weaken the immune system, putting meningitis at risk. At a more mature age, a person develops stable immunity to most of the bacteria that provoke the development of serous meningitis.

Infection routes and incubation period

There are 5 ways of infection:

Airborne - viruses are released along with the air, saliva, and tears of the patient. If a healthy person does not follow personal protective measures, the risks of infection are extremely high.
Contact - when touching the skin and mucous membranes of the patient, viruses can spread over various distances and infect several dozen people at once.
Household - the use of other people's personal hygiene items, clothing or other items guarantees infection, since viruses are perfectly adapted to life outside the human body, while maintaining their biological activity.
Water - characteristic for infection with enteroviruses that can accumulate in the intestines and are carried with the bloodstream to the brain.
From rodents - infectious disease specialists have established that rats and mice are capable of carrying viruses that can provoke meningitis.
Non-infectious - associated with the progression of tumors inside the meninges, which compress the gray matter and cause impaired brain activity.

The incubation period lasts on average 3-10 days. During this time, pathogenic microorganisms actively multiply, causing the release of serous exudate. In turn, this substance causes irritation and pressure on the lining of the brain, causing a number of characteristic neurological symptoms.

Symptoms

Symptoms of serous meningitis depend on the degree of disease progression. The manifestation of the disease is accompanied by a sharp increase in temperature, which decreases on the 3-4th day of the disease, but returns on the 5-6th day.

Manifestations in children

In childhood, in the presence of weak immunity, serous meningitis can have an acute course, the clinical manifestations of which are increasing rapidly. The child shows anxiety, constantly lies and complains of pain in the head. Cephalalgia increases with movement, so it is more convenient for the baby to lie on a flat surface with the back of the head thrown back.

A high temperature rises, after which signs of intoxication develop:

dryness of mucous membranes and skin, great thirst;
lack of appetite, nausea, gushing vomiting;
cramping abdominal pain, profuse diarrhea.

After the active production of serous exudate, neurological and meningeal symptoms develop, characteristic exclusively for meningitis:

throwing the back of the head back and tucking the legs under the chest;
constant tearfulness, lack of sleep;
muscle cramps and hypertonicity;
paresis of the limbs, decreased reflexes.

Lack of help leads to the development of an infectious-toxic shock, after which irreversible processes develop in the body.

Manifestations in adults

Serous meningitis in adults is characterized by a more prolonged incubation period and a gradual addition of clinical manifestations. The primary symptoms are associated with increasing intoxication:

decreased endurance;
lack of appetite;
muscle and joint pain.

The body temperature rises rapidly, which cannot be eliminated with the help of medicines and any available means. Cephalalgia is pronounced, which increases with light and harsh sounds. On the 5-7th day, signs of a respiratory disease appear in the form of a runny nose, cough, sore throat.

With the defeat of the cranial nerves, there is a ptosis of the upper eyelid, strabismus, impaired hearing and vision, paralysis of the facial nerves. The stiffness of the posterior cervical muscles develops, in which it is impossible to press the chin to the chest. A slight relief of general well-being occurs when the back of the head is thrown back and the legs are drawn to the chest (the pose of a cop dog).

It is extremely rare that serous meningitis provokes the development of a coma in adults. Usually, the disease slows down by 15 days, and with complex treatment, the condition improves after a week.

Diagnostics

The clinic of serous meningitis helps to suggest the presence of the disease according to the characteristic symptom complex (tilting the head back and reflex bending of the legs in the joints). But the etiology of the disease and the causative agent is determined exclusively with the help of a comprehensive diagnosis:

A blood test is not an informative indicator, since ESR and leukocytosis only slightly exceed the norm.
Examination of cerebrospinal fluid - the cerebrospinal fluid is almost transparent, sometimes it has an admixture of gray threads. There is a slight increase in protein inclusions and a decrease in glucose levels.
Crops from the throat and nose - help to determine the quantitative and qualitative composition of the microflora of the mucous membranes, identifying the pathogen.

Lumbar puncture should be performed daily, since serous meningitis is characterized by a constant change in the picture. In the first days of the manifestation of the disease, leukocytosis develops with a predominance of neutrophils. The next day, the number of lymphocytes increases. After another 2-3 days, proteins and a lack of glucose may appear in the cerebrospinal fluid.

As auxiliary research methods, the following can be used: MRI and CT of the brain, encephalogram, tuberculin tests, electroneuromyography.

Diagnosis of serous meningitis is a rather lengthy procedure. To minimize the risks of complications, therapy is started as soon as data on the etiology of the disease is obtained. Further research methods can be carried out during treatment.

Treatment

Treatment for serous meningitis depends on which pathogen triggered the meningitis. This is determined in bacterial cultures and lumbar puncture analysis.

The viral etiology of the disease is stopped with the help of antiviral therapy, which is based on medicines containing interferon. In the presence of pathologically reduced immunity, injections of immunoglobulin can be administered. Herpes infection is effectively treated with Acyclovir.

The bacterial etiology of the disease requires antibacterial therapy with broad-spectrum drugs: Ceftriaxone, Cefazolin, Cefix, Ceftazidime. In case of detection of the tuberculous nature of meningitis, anti-tuberculosis therapy is prescribed in parallel.

Restoration of the water-lytic balance is possible with the help of drip introduction of biological mixtures. With their help, you can normalize the volume of freely circulating blood, as well as speed up the process of removing toxins and toxins.

Diuretics are prescribed to prevent the development of hydrocephalus. With their help, excess fluid is removed from the body, preventing the development of edema. In the case of the development of kidney pathologies, an artificial blood purification procedure may be indicated.

Symptomatic treatment involves the use of drugs of the NSAID group, which have antipyretic and moderate analgesic effects. Neuroprotective agents and nootropics contribute to the restoration of the peripheral nervous system, as well as normalize brain activity. Anticonvulsants help to reduce muscle hypertonicity, and also help to eliminate seizures, normalizing sensitivity in the limbs.

Complications

With delayed treatment or an incorrectly selected drug, the following complications may develop:

violation of brain activity;
speech problems;
distraction of attention;
decreased fine motor skills;
squint and decreased vision quality;
hearing loss;
decreased sensitivity in the limbs;
slowing down reflexes;
epileptic seizures.

In especially advanced cases, which are preceded by the development of an infectious-toxic shock, a lethal outcome may develop. According to statistics, the serous form of meningitis is one of the easiest for the body. Mortality develops in the presence of serious immunodeficiencies and chronic diseases, which accounts for only 1% of all cases of meningitis.

The consequences of serous meningitis for the child's body are more dangerous. Impaired brain activity provokes the development of inhibition of information perception, which causes mental retardation. In older childhood, such children may differ in developmental level from their peers.

Prophylaxis

There are 5 essential prevention principles that will help reduce the likelihood of infection:

Comprehensive strengthening of immunity - during the off-season, you need to support the body with vitamin complexes, be more often in the fresh air, giving preference to proper healthy nutrition. Bad habits should be abandoned.
Minimizing contact with sick people (especially children) - in a period of high epidemiological danger, it is worth reducing visits to public places to a minimum.
Compliance with the rules of personal hygiene - hands should be washed after each visit to the toilet, as well as before eating.
Refuse to use personal hygiene items of strangers, as they can be infected.
Timely treatment of any inflammatory processes in the body, without starting them to a chronic form.

Serous-purulent meningitis requires long-term treatment and further monitoring by a specialist, which will help reduce the likelihood of relapse.

Prevention of serous meningitis in young children involves a monthly visit to the pediatrician, as well as immediate seeking help if there are characteristic signs of meningitis. Self-medication is extremely life-threatening, as it entails a number of complications.

Forecast

With proper treatment, the symptoms of meningitis begin to recede by 3-5 days, and after 10-12 days, complete recovery occurs. Periodic headaches may persist for up to 1 month, which later disappear. A favorable prognosis is mainly due to the viral etiology of the disease, which allows the body to develop its own antibodies and effectively fight pathogens.

An unfavorable prognosis is observed in the tuberculous form of meningitis, as well as with delayed treatment in the presence of an infectious-toxic shock. The risk group includes children under 1 year old and the elderly. Several specialists should deal with their treatment at once. It is extremely important to visit a neurologist once a month to monitor the rehabilitation process and further development of the child, since meningitis can cause complications.